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    Biomarkers For Myocardial Infarction, CVS Block

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    This document discusses biochemical markers for the diagnosis of myocardial infarction (MI). It defines MI as the death and necrosis of myocardial cells from prolonged, irreversible ischemia. During an MI, intracellular proteins are released into the bloodstream due to cell death. Common biochemical markers for MI diagnosis include cardiac enzymes like CK-MB and cardiac proteins like cardiac troponins and myoglobin. Of these, cardiac troponins are now the marker of choice since they are 100% specific to the heart and can detect even minor damage. Serial troponin testing is recommended for patients presenting with chest pain in order to make an early and accurate diagnosis of MI.

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    Biomarkers For Myocardial Infarction, CVS Block

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    Glucose DRglucose
    133 views13 pages
    This document discusses biochemical markers for the diagnosis of myocardial infarction (MI). It defines MI as the death and necrosis of myocardial cells from prolonged, irreversible ischemia. During an MI, intracellular proteins are released into the bloodstream due to cell death. Common biochemical markers for MI diagnosis include cardiac enzymes like CK-MB and cardiac proteins like cardiac troponins and myoglobin. Of these, cardiac troponins are now the marker of choice since they are 100% specific to the heart and can detect even minor damage. Serial troponin testing is recommended for patients presenting with chest pain in order to make an early and accurate diagnosis of MI.

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    Biomarkers for Myocardial Infarction,CVS Block

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    Biomarkers for Myocardial Infarction,CVS Block

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    This document discusses biochemical markers for the diagnosis of myocardial infarction (MI). It defines MI as the death and necrosis of myocardial cells from prolonged, irreversible ischemia. During an MI, intracellular proteins are released into the bloodstream due to cell death. Common biochemical markers for MI diagnosis include cardiac enzymes like CK-MB and cardiac proteins like cardiac troponins and myoglobin. Of these, cardiac troponins are now the marker of choice since they are 100% specific to the heart and can detect even minor damage. Serial troponin testing is recommended for patients presenting with chest pain in order to make an early and accurate diagnosis of MI.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    133 views13 pages

    Biomarkers For Myocardial Infarction, CVS Block

    Uploaded by

    Glucose DRglucose
    This document discusses biochemical markers for the diagnosis of myocardial infarction (MI). It defines MI as the death and necrosis of myocardial cells from prolonged, irreversible ischemia. During an MI, intracellular proteins are released into the bloodstream due to cell death. Common biochemical markers for MI diagnosis include cardiac enzymes like CK-MB and cardiac proteins like cardiac troponins and myoglobin. Of these, cardiac troponins are now the marker of choice since they are 100% specific to the heart and can detect even minor damage. Serial troponin testing is recommended for patients presenting with chest pain in order to make an early and accurate diagnosis of MI.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 13

    Cardiovascular Block

    Medical Biochemistry Course

    Biochemical Markers
    for Diagnosis of

    Myocardial Infarction
    Dr. Aida Ahmad Abd Elhamed
    Lecturer of Clinical Pathology

    ?What is Myocardial Infarction


    Myocardial ischemia results from the reduction of coronary
    blood flow to an extent that leads to insufficiency of oxygen
    supply to myocardial tissue
    When this ischemia is prolonged & irreversible, myocardial
    cell death & necrosis occurs ---this is defined as:
    myocardial infarction

    is the death & necrosis of myocardial cells


    as a result of coronary prolonged & irreversible
    ischemia

    Biochemical Changes in Acute Myocardial Infarction


    (mechanism of release of myocardial markers)
    ischemia to myocardial muscles (with low O2 supply)
    anaerobic glycolysis
    increased accumulation of Lactate
    decrease in pH
    activate lysosomal enzymes
    disintegration of myocardial proteins
    cell death & necrosis

    clinical manifestations
    (chest pain)

    release of intracellular
    contents to blood

    BIOCHEMICAL
    MARKERS

    ECG
    changes

    Diagnosis of Myocardial Infarction

    SHOULD depend on THREE items


    (as recommended by WHO)
    1- Clinical Manifestations
    2- ECG
    3- Biochemical Markers

    criteria for ideal markers


    for myocardial infarction
    1- Specific:
    2- Sensitive:

    to myocardial muscle cells (no false positive)


    - rapid release on onset of attack (diagnose early cases)
    - so, can detect minor damage
    - no miss of positive cases (no false negative)

    3- Prognostic: relation between plasma level & extent of damage


    4- Persists longer: so, can diagnose delayed admission
    6- Reliable: procedure depends on evidenced principle
    5- Simple, inexpensive:

    - can be performed anywhere by low costs


    - no need for highly qualified personnel

    7- Quick: low turnaround time

    Biochemical Markers for


    Myocardial Infarction

    Types of

    1- Cardiac Enzymes (isoenzymes):


    Total CK
    CK-MB activity
    CK-MB mass
    2- Cardiac proteins:
    Myoglobin
    Troponins

    BIOCHEMICAL MARKERS IN
    MYOCARDIAL ISCHAEMIA / NECROSIS

    RECENT

    CK-MB (mass)
    c.Troponins (I or T)
    Myoglobin

    :FUTURE
    Ischaemia Modified Albumin
    Glycogen Phosphorylase BB
    Fatty Acid binding Protein
    .Highly sensitive CRP

    Traditional
    AST activity
    LDH activity
    LDH isoenzymes
    CK-Total
    CK-MB activity
    CK-Isoenzymes

    Cardiac Enzymes
    Total CK

    (sum of CK-MM, CK-MB & CK-BB)

    non specific to cardiac tissue (available in skeletal ms.)

    CK-MB (CK-2) activity


    more specific than total CK
    BUT: less specific than troponin I (available in sk. Ms)
    appears in blood: within 4-6 hours of onset of attack
    peak:
    12 - 24 hours
    returns to normal: within 2 - 3 days (no long stay in blood)
    Advantages: - useful for early diagnosis of MI
    - useful for diagnosis reinfarction
    Disadvantages: not used for delayed admission (more than 2 days)
    not 100% specific (elevated in sk.ms damage)

    CK-MB mass
    - appears one hour earlier than CK-MB activity (more sensitive)
    - So, useful for diagnosis of early cases & reinfarction
    - BUT: not for diagnosis of delayed admission cases
    & less specific than troponin I

    Relative index = CK-MB mass / Total CK X 100


    more than 5 % is indicative for MI

    Cardiac Proteins
    Myoglobin
    cytosolic protein
    - not specific for cardiac tissue (also in sk.ms. & renal tissue)
    - appears in blood EARLIER than other markers (within 1-4 hours)
    So, with high sensitivity
    - BUT: Returns to normal in 24 hours
    So, not for delayed admission cases (after one day of onset
    of attack)

    Cardiac Troponins
    Protein complex located on the thin filament of striated muscles
    consists of 3 subunits: cTn T, cTnI & cTn C
    with different structures & functions

    cTnI & cTnT are used are biomarkers for MI diagnosis


    Cardiac troponins (cTn) are different from skeletal muscle tropnins
    So, more specific for MI diagnosis

    cTnI:

    100 % cardiac specific


    With greater sensitivity for diagnosing minor damage of MI
    Appears in blood within 6 hours after onset of infarction
    peak: around 24 hours
    Disappears from blood after about one week (stays longer)
    So, useful for diagnosis of delayed admission cases
    Prognostic marker (relation between level in blood & extent of cardiac damage)

    Recommendations for use of biochemical


    markers for diagnosis of myocardial infarction
    1- Recommended for all patients complaining of chest pain (with clinical examination & ECG)
    2- Sample
    Type:
    plasma
    Timing: i. on admission
    ii. serial ( at least every one hour in a period 6-9 hours)
    should be referenced to admission & onset of pain
    3- Test should be with low turnaround time
    less than one hour (accepted)
    less than half an hour is preferred
    4- Types of Markers used: two types
    early markers: as Myoglobin: appears in blood early (within less 4 fours)
    BUT not specific & not persists for long period (less than 2 days)
    definitive markers: Troponin:

    appears in blood later than myoglobin (within 6 hours)


    BUT 100% specific, prognostic & stays longer (one week)

    5- Troponin is currently the marker of choice


    should be available in all cardiac & emergency centers
    (if not, CK-MB mass is the second choice)

    THANK YOU

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